ACKNOWLEDGEMENTS The Healthy Start of North Central Florida Coalition’s 2021 Service Delivery Plan (SDP) is the result of a collaboration between many individuals and organizations without whom this immense undertaking could not have been achieved. Survey Monkey was used to create surveys and those survey links were sent to diverse populations across our twelve counties to gain valuable insight from those whom the Coalition serves. We are grateful to the Healthy Start home visitors, physician providers, community agencies, and Healthy Start participants who participated in the assessment. The Board of Directors and coalition members guided the process by participating in the community needs assessment, reviewing the maternal and child health indicator and assessment data to develop priorities, strategies, and action steps. The Coalition deeply appreciate everyone’s efforts and time that made this endeavor possible. TABLE OF CONTENTS ACKNOWLEDGMENTS 2 HEALTHY START BACKGROUND AND COALITION STRUCTURE 6 Healthy Start Initiative 7 Healthy Start Coalition 9 Healthy Start Providers 10 PROCESS USED TO UPDATE THE SERVICE DELIVERY PLAN 14 Methodology for Needs Assessment 15 Summary of Data Sources 16 SUMMARY OF FINDINGS FROM THE NEEDS ASSESSMENT 18 Key Findings 19 Screening Rates 22 Healthy Start Services 24 MAJOR HEALTH INDICATORS SELECTED 28 Infant Mortality 29 Neonatal Mortality 32 Postneonatal Mortality 34 Fetal Mortality 36 Preterm Births 38 Low Birth Weight 41 Very Low Birth Weight 43 TARGET POPULATION 45 Population Characteristics 46 Births 57 FACTORS CONTRIBUTING TO THE HEALTH STATUS INDICATORS 65 Prenatal Care 66 Inter-Pregnancy Interval 71 BMI Prior to Pregnancy (Overweight/Obese) 73 Smoked During Pregnancy 75 Breastfeeding 76 Births to Unwed Mothers 78 Father Not on Birth Certificate 79 Sudden Unexpected Infant Death 80 Unintentional Injuries 82 3 P a g e 3 TABLE OF CONTENTS Substance Exposed Newborns & Neonatal Abstinence 85 Comparison of SDP Plans 88 CONSUMER AND PROVIDER INPUT 89 Partner Agency Survey 90 General Survey 95 Healthy Start Participant Survey 101 Healthy Start Provider Survey 108 Prenatal Health Care Provider Survey 112 Postnatal Health Care Provider Survey 118 Pediatric Health Care Provider Survey 123 RESOURCE INVENTORY 128 Alachua County 129 Bradford County 133 Columbia & Hamilton Counties 136 Dixie, Gilchrist & Levy Counties 140 Lafayette & Suwannee Counties 144 Marion County 147 Putnam County 151 Union County 154 HEALTH STATUS PROBLEM LINKED TO ACTION PLAN 157 Health Problem Analysis 158 QUALITY IMPROVEMENT/QUALITY ASSURANCE PLAN 164 Continuous Quality Improvement Plan 165 Financial Monitoring Process 173 Coalition Board Responsibilities 176 PROCESS FOR ALLOCATING FUNDS 179 Service Budget 2020-2021 180 Funding Allocation Methodology 181 NEW STRATEGIC PLAN 182 Objective One 183 Objective Two 184 Objective Three 185 P a g e 4 TABLE OF CONTENTS Objective Four 188 Objective Five 189 Objective Six 190 APPENDICES 191 Board Members 192 Surveys 193 Screening Forms 201 5 P a g e 5 HEALTHY START BACKGROUND & COALITION STRUCTURE HEALTHY START BACKGROUND AND COALITION STUCTURE FLORIDA’S HEALTHY START INITIATIVE The Florida Legislature passed the Healthy Start Initiative (s.282.2161, F.S.) in 1991 with leadership from the late Governor Lawton Chiles. The impetus for the initiative was Florida’s poor standing on key maternal and infant health indicators—infant mortality, low birth weight, teen pregnancy, and access to prenatal care. Through the Healthy Start Initiative, all babies born in the state of Florida are given the opportunity to have a healthy start in life. The key components of the statute mandated: 1) Universal screening for pregnant women and newborns to identify those at risk for poor birth, health and development outcomes 2) Increased access to comprehensive, risk-appropriate maternity and well-child care and support services 3) State-wide implementation of community-based care coordination systems 4) Expansion of Medicaid funding and expanded eligibility for pregnant women 5) Formation of local Coalitions to spearhead system change through public and/or private partnerships at the community level and leverage additional resources. The state agency designated to administer Florida’s maternal and child health services is the Florida Department of Health (DOH). DOH currently contracts with 32 Healthy Start Coalitions around the state of Florida to address the key components of the Healthy Start Initiative to improve the health of pregnant women and infants in their communities. The legislatively mandated responsibilities of Healthy Start Coalitions include: increasing public awareness of the issues related to infant mortality; building and maintaining broad community support; selecting and contracting with local providers for the delivery of Healthy Start services; performing on-going monitoring and evaluation of contracted services; and conducting short and long range planning for the local maternal and infant populations. Healthy Start System Components The Healthy Start system has three main components: universal screening, core and enhanced Healthy Start services, and community-based planning and system management. The goal of all three components is to improve access to prenatal care for pregnant women, provide care coordination and needed services for at-risk women, and ensure good health outcomes for mothers and their babies. Universal Screening. Initial identification of risks is accomplished through standardized screening of the mother while pregnant and of the baby immediately after birth. Florida law mandates that physicians offer these screenings to all patients. 7 P a g e 7 HEALTHY START BACKGROUND AND COALITION STUCTURE The standardized prenatal screening instrument for pregnant women includes a series of questions focusing on medical, environmental and psychosocial factors that are known, based on documented research, to be associated with increased risk of adverse outcomes. The infant screen is completed in conjunction with the birth certificate. The risk factors examined are similar to those on the prenatal screen and include age, race, health, marital status, and educational level of the mother; late or no prenatal care; low birthweight; tobacco, drug and alcohol use; and presence of congenital anomalies. Core and enhanced Healthy Start Services. Healthy Start provides one-on-one support to assist a mother throughout her pregnancy and after the birth of her baby. A Healthy Start Home Visitor meets with the participant in her doctor’s office, her home or any other place that is convenient for her. The Healthy Start Home Visitor assists the participant with services and education to help them have a health pregnancy and a healthy baby. Services include the following: • Home Visiting: One-on-one support in the home or another convenient location; friendly advisors throughout pregnancy and after the baby is born; access to services that are designed to meet unique needs. • Prenatal Education & Support: Information on changes that happen to a woman’s body and emotions during pregnancy; what to expect during labor and delivery; nutrition, medicine and exercise that can help or harm a pregnant woman or baby; warning signs of an early delivery. • Breastfeeding Education & Support: Techniques for successful and enjoyable breastfeeding; information on how breastfeeding benefits mom and baby. • Newborn Care: Tips on how to take care of a new baby, keeping baby safe according to the latest safety guidelines on sleep, car seats and more; infant nutrition; proper growth for baby. • Parenting Education & Support: Preparation for baby coming home; tracking and supporting baby’s development; ways to play and connect with baby; how to become baby’s first teacher. • Health and Well-Being: Help with planning for future pregnancies; making healthy lifestyles choices for the family; getting support for feeling anxious, stressed or having the “Baby Blues.” Healthy Start provides a personal Healthy Start home visitor to assist the mother with services throughout her prenatal care and after the birth of her baby. Community-Based Planning and System Management. Healthy Start coalitions conduct needs assessments of the maternal and child health systems within their service area, and prepare a plan for community action to improve maternal and child health outcomes. Coalitions are responsible for allocating funds, selecting providers to deliver specific services and monitoring the performance of providers to ensure quality care and focus on improved outcomes. P a g e 8 HEALTHY START BACKGROUND AND COALITION STUCTURE HEALTHY START COALITION The Central Healthy Start Coalition is one of 32 Healthy Start Coalitions in Florida established to improve the health and developmental outcomes of pregnant women, infants and families in Florida. The mission of the Coalition is to create a collaborative partnership to ensure maternal and child health through proactive planning and cost effective allocation of resources. The Coalition was incorporated in 1992 and selected as one of the first coalitions in the state to focus attention and resources on Florida’s maternal and child health needs. The community-based coalition serves the counties of Citrus, Hernando, Lake and Sumter. Board of Directors and General Members The Coalition maintains an open general membership that is available to all persons interested in maternal and child health. The general membership including representatives from healthcare providers, consumers,